Enrollment Screen Element Reference

Table 1. Key screen elements in Enrollment
Screen Element	Description
Accepts Secondary (column)	EDI Payer List Screen and Linked Payers Screen Indicates if the payer accepts secondary claims. Yes or No.
Accepts Secondary (filter option)	EDI Payer List Screen Yes – Payers that Accepts Secondary are shown. No – Payers that do not Accept Secondary are shown. All - All payers are shown.
Accounts (filter option)	Linked Payers Screen Filters based on the select account: Client Code \| Tax ID \| NPI. Supports auto-complete search.
Actions (column)	Search Enrollment and Search New Payer Connection Request Forms Select the dropdown arrow next to Select to do one of the following: Add Note - A mandatory free text field allowing 256 characters. Email - Option only available for a finalizes form Download - Select to download enrollment form Edit - Select to edit form in any status. note: Edit is disabled if a form status is auto updated by the system. View History - Select to view actions performed on current form. If form is replaced with a new form, the history will not show actions performed on the older form. Any status auto updated will display "EDI" Print - Prints the enrollment form.
Add Column	Linked Payers Screen Select columns from the drop-down to add to the standard columns already displayed.
Client Code (column)	Select Accounts(s) and Manage Accounts Screens Displays the client code. If the account is a default account, then is shown. Search Enrollment Forms Screen This behaves like Group in the legacy system. Linked Payers Screen This column will not display if Unlinked option is selected.
Client Code (filter option)	Search Enrollment Forms Screen Multi-select client codes and from the drop-down. Linked Payer Multi-select client codes and from the drop-down. Temporarily, the multi-select is not available when Unlinked (Payer) filter is selected. This will be available in the future. Search New Payer Connection Request Forms Screen Searches on client code. Supports auto complete search.
Client Code (entry field)	Create New Account Screen This field is same as Group in the Legacy system.
Date Added (filter option)	EDI Payer List Screen Searches EDI Payer data based on start and end date range. This reflects the last updated date range.
Destination Payer ID (filter option) (column)	Linked Payers Screen Searches on the Destination Payer ID. This field supports alphanumeric characters.
Export Icon	On Multiple Screens Data is downloaded to Excel.
Email (action button)	Enrollment Form Status Screen Form is emailed to the logged-in user email ID(s).
Enrollment Required (column)	EDI Payer List Screen Indicates whether enrollment or route setup request is required (Yes, GR, No). Hover on the i to review instructions and notes. Yes - when selected launches enrollment form. GR - indicates the payer requires route setup and when selected initiates the GR route setup request. NA - Not Applicable No - No enrollment required.
Enrollment Required (filter option)	EDI Payer List Screen Yes – EDI Payer data with Enrollment Required as Yes is shown. No – EDI Payer data with Enrollment Required as No are shown. GR – No enrollment with the payer is required. GR Route setup required with EDI.
Expected Date	Search Enrollment Forms Screen Displays expected approval date of the enrollment form. If Expected Date is defined for the payer, then expected date will be calculated based on this from the date ‘Manually Submitted to Payer.’ If Expected Date is not defined for the payer, then expected date will be calculated 45 days from the date ‘Manually Submitted to Payer.’
Fill Forms (action button)	EDI Payer List Screen Launches enrollment form.
Filter (field)	All screens Displays Default if no filters are applied. Hovering over will show the default filters. Displays Applied if filters are selected. Hovering over will show the selected filters.
Form Fill Status (filter option)	Linked Payers Screen Filters data based on the form fill status (multiple statuses can be selected). All Not Filled Not Required Finalized Draft Route Request not Submitted Route Request Submitted Route Request Completed Note: Payers for whom the forms are not available will be shown on selecting the form status as NF - Not Filled.
Form Fill Status (column)	Linked Payers Screen Displays the form fill status. All Not Filled Not Required Finalized Draft Route Request not Submitted Route Request Submitted Route Request Completed note: Route Request not Submitted displays as a hyperlink and can be selected to initiate a new route request. Refer to Creating a New Route Request for athenaIDX and athenaPractice or Creating a New GR Route Request for Group Management
Form ID (column)	Search Enrollment Forms Screen Form ID is generated when selecting GR in EDI Payer List. Form ID is generated for each payer for whom instructions page is viewed. Hovering over the ID displays the ID details.
Form Status & Last Update (column)	Search Enrollment Forms Screen Displays the status and latest update along with user who made the last update. Status displays as a hyperlink enabling you to change the status. Select the down arrow to change the status. Select the to open the filled enrollment form in edit mode. User will be able to edit the form details. The following fields are auto-filled and can't be edited: Client Code Payer ID Payer Name A note and reason for change in status also displays if added. For payers whom a route request is submitted, this column displays data without any hyperlink for athenaIDX and athenaPractice. For Group Management, Status displays as a hyperlink. note: Updating the status is disabled if a form status is auto updated by the system.
Insurance Type (filter)	EDI Payer List Screen Searches EDI Payer List data based on the selected Insurance Type(s). By default, Commercial, BCBS, Medicare, Railroad Medicare, Medicaid, TRICARE/CHAMPUS are selected. Allows multiple selection of values.
Link (action button)	Available Accounts Screen Links selected payers to selected accounts
Link Payers (action button)	EDI Payer List Screen Launches Select Account(s) screen to link account(s) to selected payer(s).
LOB (column)	EDI Payer List Screen Line of Business.
LOB (filter option)	EDI Payer List Screen and Linked Payers Screen Searches EDI Payer data based on LOB (Line of Business). Allows selection of multiple values. Search Enrollment Forms Screen A combination of Transaction and Enroll Type in the legacy system. Allows selection of multiple values. By default Claim-l, Claim-P, Remit-l, Remit-P, and Eligibility-A are selected.
New Payer Connection (action button)	Search New Payer Connection Request Forms Screen Select to create a new payer connection request.
Next Form (action button)	Enrollment Form Status Screen The next enrollment form opens for the user to complete.
NPI (column and filter option)	On Multiple Screens (searchable on some screens) NPI = National Provider Identifier. Linked Payers Screen Displays the NPI. This column will not be shown if Unlinked option is selected.
Payers (filter option)	Linked Payers Screen Linked – If checked, payers linked to an account will be displayed. Unlinked – If checked, payers not linked to any account will be displayed.
Payer Name (column)	EDI Payer List Displays an information icon if there is payer specific notes or instructions (regardless of Enrollment Required status). This only displays on the EDI Payer List.
Preferences (options)	Create Account Screen Select from the following: Default - This check box is unchecked by default. If checked, the account is considered as default. Default accounts cannot be made inactive Skip Account Selection - This option is enabled only for an account marked as Default. Account selection is skipped. Default account created is selected in the backend. Pre-populate Data - Select to pre-populate account details on the enrollment form if this account is selected. Selected by default.
Reset to Default (action button)	EDI Payer List Screen Default values are: LOB: All Insurance Type: All State: All Enrollment Required: Yes, No, GR Accepts Secondary: All Search Enrollment Forms Screen Default values are: LOB: All Status: Form populated: Okay to print, Form manually submitted to Payer, Payer Confirmation: Denied, Payer Confirmation: Approved, Draft, Clearinghouse Approved: Payer Pending, Clearinghouse Approved: Payer Approved Clearinghouse Approved: Payer Denied, Clearinghouse: Approved, Clearinghouse Denied Form Created Date: Last 7 days State: All Linked Payers Screen Form Fill Status: Not Filled, Draft, LOB: All Insurance Type: All State: All Accepts Secondary: All Payers: Linked Search New Payer Connection Request Forms Status: All Transaction: Professional Claims, Institutional Claims, Professional Electronic Remittance, Institutional Electronic Remittance, Real Time Eligibility Form Created Date: Last 7 days
Routing Multistate ID (filter option) (column)	EDI Payer List and Linked Payers Screen Searches on the Routing Multistate ID. This field supports alphanumeric characters. Hovering over the information icon in the column displays the TPA name.
Show Inactive Only (filter option)	Manage Accounts Screen If selected, inactive accounts are shown.
Form Status and Last Update (column)	Search Enrollment Forms Screen Displays current status of the enrollment form. Allows the user to change the form status. Values are: Form Populated: Okay to Print Form manually Submitted to Payer Payer Confirmation: Approved Payer Confirmation: Denied Clearinghouse Approved: Payer Pending Clearinghouse Approved: Payer Approved Clearinghouse Approved: Payer Denied Clearinghouse Approved Clearinghouse Denied Route Request Submitted Route Request Completed note: There is no restriction on the order in which the status can be assigned to the form. Even if the status is auto approved for the form, status can still be changed. If status of a GR route request is auto updated to Completed, the status cannot be changed. New Payer Connection Form Select a status from the Status column: All Payer Transaction Requested Payer Transaction Live Payer Transaction Unavailable note: Post auto approval (status set to approved), if status is changed manually to any other status, automatic approval logic is not applied again on this form. This also holds true if the status of the form gets changed on Edit action.
Status (filter option)	Search Enrollment Forms Screen Allows selection of multiple values. Values are: All Draft Payer Confirmation: Approved Payer Confirmation: Denied Manually Submitted to Payer Form Populated: Okay to Print Clearinghouse Approved: Payer Pending Clearinghouse Approved: Payer Approved Clearinghouse Approved: Payer Denied Clearinghouse Approved Clearinghouse Denied Route Request Submitted Route Request Completed By default all are selected except Route Request Submitted and Route Request Completed.
Tax ID (column)	Linked Payers Screen Displays the Tax ID. This column will not display if Unlinked option is selected.
Transactions Needed (options)	New Payer Connection Request Form Select the transactions for which new payer connection request needs to be raised. Multiple transactions can be selected, select all that apply.